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Suicide in Psychiatric Patients: Risk and Prevention

Published online by Cambridge University Press:  02 January 2018

Louis Appleby
Louis Appleby*
Affiliation:
Department of Psychiatry, University Hospital of South Manchester, Manchester M20 8LR
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Abstract

The prevention of suicide requires an understanding of protective as well as risk factors, and the recognition of high-risk groups. Factors which increase the risk in patient populations include previous parasuicide, recent relapse or discharge, features of mental state (depression, psychosis), social circumstances (isolation, unemployment), and demographic characteristics (male sex, young age). Protective factors are under-researched but are likely to lie in the nature of psychiatric care. Consequently, community care may affect suicide by altering the level of protection at critical periods in an episode of illness. The clinical prevention of suicide should therefore be a priority for community services, and the relationship between suicide and mental health care should be researched by a national process of monitoring.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 161 , Issue 6 , December 1992 , pp. 749 - 758
Copyright
Copyright © 1992 The Royal College of Psychiatrists 

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References

Allebeck, P. & Wistedt, B. (1986) Mortality in schizophrenia. A ten-year follow-up based on the Stockholm County in-patient register. Archives of General Psychiatry, 43, 650–653.CrossRefGoogle Scholar
Allebeck, P., Varla, A., Kristjansson, E., et al (1987) Risk factors for suicide among patients with schizophrenia. Acta Psychiatrica Scandinavica, 76, 414–419.Google Scholar
Allebeck, P. & Allgulander, C. (1990) Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatrica Scandinavica, 81, 565–570.Google Scholar
Anonymous (1977) A suicide epidemic in a psychiatric hospital. Diseases of the Nervous System, 38, 327–331.Google Scholar
Appleby, L. (1991) Suicide during pregnancy and in the first postnatal year. British Medical Journal, 302, 137–140.Google Scholar
Barraclough, B. M., Bunch, J., Nelson, B., et al (1974) A hundred cases of suicide. British Journal of Psychiatry, 125, 355–373.Google Scholar
Beck, A. T., Steer, R. A., Kovacs, M., et al (1985) Hopelessness and eventual suicide: a 10–year prospective study of patients hospitalised with suicidal ideation. American Journal of Psychiatry, 142, 559–563.Google ScholarPubMed
Beck, A. T. & Steer, R. A. (1989) Clinical predictors of eventual suicide: a five- to ten-year prospective study of suicide attempters. Journal of Affective Disorders, 17, 203–209.CrossRefGoogle Scholar
Berglund, M. (1984) Suicide in alcoholism. A prospective study of 88 suicides: I. The multidimensional diagnosis at first admission. Archives of General Psychiatry, 41, 888–891.CrossRefGoogle ScholarPubMed
Berglund, M. & Nilsson, K. (1987) Mortality in severe depression. A prospective study including 103 suicides. Acta Psychiatrica Scandinavica, 76, 372–380.Google Scholar
Cantor, C. H., Hill, M. A. & McLachlan, E. K. (1989) Suicide and related behaviour from river bridges. A clinical perspective. British Journal of Psychiatry, 155, 829–835.Google Scholar
Cohen, L. J., Test, M. A. & Brown, R. L. (1990) Suicide and schizophrenia: data from a prospective community treatment study. American Journal of Psychiatry, 147, 602–607.Google Scholar
Copas, J. B., Freeman-Browne, D. L. & Robin, A. A. (1971) Danger periods for suicide in patients under treatment. Psychological Medicine, 1, 400–404.Google Scholar
Coser, R. L. (1976) Suicide and the relational system: a case study in a mental hospital. Journal of Health and Social Behaviour, 17, 318–327.CrossRefGoogle Scholar
Crammer, J. L. (1984) The special characteristics of suicide in hospital in-patients. British Journal of Psychiatry, 145, 460–476.Google Scholar
Crawford, J. P. & Willis, J. H. (1966) Double suicide in psychiatric hospital patients. British Journal of Psychiatry, 112, 1231–1235.CrossRefGoogle ScholarPubMed
Department of Health (1990) Report on Confidential Enquiries into Maternal Deaths in England and Wales. London: HMSO.Google Scholar
Drake, R. E., Gates, C., Cotton, P. G. et al (1984) Suicide among schizophrenics. Who is at risk? Journal of Nervous and Mental Disease, 172, 613–617.CrossRefGoogle ScholarPubMed
Drake, R. E. & Cotton, P. G. (1986) Depression, hopelessness and suicide in chronic schizophrenia. British Journal of Psychiatry, 148, 554–559.CrossRefGoogle ScholarPubMed
Farmer, R. D. T. & Pinder, R. M. (1989) Why do fatal overdose rates vary between antidepressants? Acta Psychiatrica Scandinavica, 80 (suppl. 354): 25–35.Google Scholar
Fawcett, J., Scheftner, W., Clark, D., et al (1987) Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. American Journal of Psychiatry, 144, 35–40.Google Scholar
Fawcett, J., Fogg, L., et al (1990) Time-related predictors of suicide in major affective disorder. American Journal of Psychiatry, 147, 1189–1194.Google Scholar
Flood, R. A. & Seager, C. P. (1968) A retrospective examination of psychiatric case records of patients who subsequently committed suicide. British Journal of Psychiatry, 114, 443–450.Google Scholar
Gale, S. W., Mesnikoff, A., Fine, J., et at (1980) A study of suicide in state mental hospitals in New York City. Psychiatric Quarterly, 52, 201–213.CrossRefGoogle ScholarPubMed
Goh, S. E., Salmons, P. H. & Whittington, R. M. (1989) Hospital suicides: are there preventable factors? Profile of the psychiatric hospital suicide. British Journal of Psychiatry, 154, 247–249.Google Scholar
Guze, S. B. & Robins, E. (1970) Suicide and primary affective disorder. British Journal of Psychiatry, 117, 437–438.Google Scholar
Jensen, L. (1966) Nosocomial suicides and suicides among discharged patients. Acta Psychiatrica Scandinavica, 42 (suppl. 191): 149–170.Google Scholar
Kahne, M. J. (1968) Suicides in mental hospitals: a study of the effects of personnel and patient turnover. Journal of Health and Social Behaviour, 9, 255–266.Google Scholar
Kendell, R. E., Chalmers, J. C. & Platz, C. (1987) Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150, 662–673.Google Scholar
King, E. & Barraclough, B. (1990) Violent death and mental illness. A study of a single catchment area over 8 years. British Journal of Psychiatry, 156, 714–720.CrossRefGoogle Scholar
Kraft, D. P. & Babigian, H. M. (1976) Suicide by persons with and without psychiatric contacts. Archives of General Psychiatry, 33, 209–215.Google Scholar
Kumar, R. & Robson, K. M. (1984) A prospective study of emotional disorders in childbearing women. British Journal of Psychiatry, 144, 35–47.Google Scholar
Langley, G. E. & Bayatti, N. (1984) Suicides in Exe Vale Hospital 1972–1981. British Journal of Psychiatry, 145, 463–467.Google Scholar
Lewis, G. & Appleby, L. (1988) Personality disorder: the patients psychiatrists dislike. British Journal of Psychiatry, 153, 44–49.Google Scholar
Linehan, M. M., Goodstein, J. L., Nielsen, S. L., et al (1983) Reasons for staying alive when you are thinking of killing yourself: the Reason For Living inventory. Journal of Consulting and Clinical Psychology, 51, 276–286.CrossRefGoogle ScholarPubMed
Martin, R. L., Cloninger, R., Guze, S. B., et al (1985) Mortality in a follow-up of 500 psychiatric outpatients II. Cause-specific mortality. Archives of General Psychiatry, 42, 58–66.CrossRefGoogle Scholar
Modestin, J. (1985) Antidepressive therapy in depressed clinical suicides. Acta Psychiatrica Scandinavica, 71, 111–116.Google Scholar
Modestin, J. & Wurmle, O. (1989) Role of modelling in in-patient suicide: a lack of supporting evidence. British Journal of Psychiatry, 155, 511–514.CrossRefGoogle ScholarPubMed
Morgan, H. G. & Priest, P. (1984) Assessment of suicide risk in psychiatric in-patients. British Journal of Psychiatry, 145, 467–469.Google Scholar
Morgan, H. G. & Priest, P. (1991) Suicide and other unexpected deaths among psychiatric in-patients. The Bristol Confidential Inquiry. British Journal of Psychiatry, 158, 368–374.Google Scholar
Murphy, G. E., Armstrong, J. W., Hermele, S. L., et al (1979) Suicide and alcoholism. Interpersonal loss confirmed as a predictor. Archives of General Psychiatry, 36, 65–69.CrossRefGoogle ScholarPubMed
Myers, D. H. & Neal, C. D. (1978) Suicide in psychiatric patients. British Journal of Psychiatry, 133, 38–44.Google Scholar
Office of Population Censuses and Surveys (1990) Mortality Statistics: Cause. London: HMSO.Google Scholar
Ovenstone, I. M. K. & Kreitman, N. (1974) Two syndromes of suicide. British Journal of Psychiatry, 124, 336–345.Google Scholar
Perris, C., Beskow, J. & Jacobson, L. (1980) Some remarks on the incidence of successful suicide in psychiatric care. Social Psychiatry, 15, 161–166.Google Scholar
Pokorny, A. D. (1964) Suicide rates in various psychiatric disorders. Journal of Nervous and Mental Disease, 139, 499–506.Google Scholar
Pokorny, A. D. (1966) A follow-up study of 618 suicidal patients. American Journal of Psychiatry, 122, 1109–1116.Google Scholar
Pokorny, A. D. (1983) Prediction of suicide in psychiatric patients. Report of a prospective study. Archives of General Psychiatry, 40, 249–257.Google Scholar
Pounder, D. J. (1985) Suicide by leaping from multistorey car parks. Medicine, Science and the Law, 25, 179–188.Google Scholar
Regier, D. A., Hirschfield, R. M., Goodwin, F. K., et al (1988) The NIMH Depression Awareness, Recognition, and Treatment Program: structure, aims, and scientific basis. American Journal of Psychiatry, 145, 1351–1357.Google Scholar
Rich, C. L., Fowler, R. C., Fogarty, L. A., et al (1988) San Diego suicide study. III. Relationship between diagnoses and stressors. Archives of General Psychiatry, 45, 589–592.Google Scholar
Robin, A. A., Brooke, E. M. & Freeman-Browne, D. L. (1968) Some aspects of suicide in psychiatric patients in Southend. British Journal of Psychiatry, 114, 739–747.CrossRefGoogle ScholarPubMed
Robins, E., Murphy, G. E., Wilkinson, R. H., et al (1959a) Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. American Journal of Public Health, 49, 888–899.Google Scholar
Robins, E., Gassner, S. & Kayes, J. (1959b) The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide. American Journal of Psychiatry, 115, 724–733.Google Scholar
Rorsmann, B. (1973) Suicide in psychiatric patients: a comparative study. Social Psychiatry, 8, 55–66.CrossRefGoogle Scholar
Roy, A. (1982a) Risk factors for suicide in psychiatric patients. Archives of General Psychiatry, 39, 1089–1095.CrossRefGoogle ScholarPubMed
Roy, A. (1982b) Suicide in chronic schizophrenia. British Journal of Psychiatry, 141, 613–617.Google Scholar
Rutz, W., Von Knorring, L. & Wolinder, J. (1989) Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatrica Scandinavica, 80, 151–154.Google Scholar
Salmons, P. H. (1984) Suicide in high buildings. British Journal of Psychiatry, 145, 469–472.Google Scholar
Schou, M. & Weeke, A. (1988) Did manic depressive patients who committed suicide receive prophylactic or continuation treatment at the time? British Journal of Psychiatry, 153, 324–327.Google Scholar
Sims, A. & Prior, P. (1978) The pattern of mortality in severe neuroses. British Journal of Psychiatry, 133, 299–305.CrossRefGoogle ScholarPubMed
Sims, A. & O'Brien, K. (1979) Autokabalesis: an account of mentally ill people who jump from buildings. Medicine, Science and the Law, 19, 195–198.Google Scholar
Sundqvist-Stensman, U. B. (1987) Suicides in close connection with psychiatric care: an analysis of 57 cases in a Swedish county. Acta Psychiatrica Scandinavica, 76, 15–20.Google Scholar
Temoche, A., Pugh, T. F. & McMahon, B. (1964) Suicide rates among current and former mental institution patients. Journal of Nervous and Mental Disease, 138, 124–131.Google Scholar
Virkkunen, M. (1976) Attitude to psychiatric treatment before suicide in schizophrenia and paranoid psychoses. British Journal of Psychiatry, 128, 47–49.Google Scholar
Walk, D. (1967) Suicide and community care. British Journal of Psychiatry, 113, 1381–1391.CrossRefGoogle ScholarPubMed
Wilkinson, G. & Bacon, N. A. (1984) A clinical and epidemiological survey of parasiticide and suicide in Edinburgh schizophrenics. Psychological Medicine, 14, 899–912.CrossRefGoogle Scholar
Williams, P., De Salvia, D. & Tansella, M. (1986) Suicide, psychiatric reform, and the provision of psychiatric services in Italy. Social Psychiatry, 21, 89–95.Google Scholar
Zemishlany, Z., Weinberger, A., Ben-Bassat, M., et al (1987) An epidemic of suicide attempts by burning in a psychiatric hospital. British Journal of Psychiatry, 150, 704–706.CrossRefGoogle ScholarPubMed
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